Friday, March 17, 2017

How a Patient Ends Up on Isolation Precautions: In Five Simple Steps


A guest post

You enter your unit and receive morning report. Mr. Z, a 68-year-old gentleman with diagnosis cellulitis of the left leg was previously on standard precautions at the time you clocked out yesterday evening. You notice that he now has an isolation cart parked outside of his room with a large sign indicating contact precautions are needed. Yesterday you spent hours in his room wearing only gloves, yet now you are being asked to don a protective gown over your clothing. What changed in twelve hours that warranted this?


Image credit: Koldunov

After reviewing Mr. Z’s chart you recognize the familiar acronym: MRSA, or Methicillin Resistant Staphylococcus Aureus.

Background
What does this mean? What exactly is MRSA and why does Mr. Z have this diagnosis when yesterday he did not?
Quite simply, all humans harbor bacteria. Bacteria lives on our skin, in our gut, and even in our blood and mucus membranes! Most of these bacteria are harmless, part of normal human flora. Sometimes, however, an unwanted or dangerous bacteria enters our system which leads us to develop an infection. Most bacteria are susceptible to broad range antibiotics, such as levofloxacin, ciprofloxacin or sulfamethoxazole. These are common antibiotics your doctor may prescribe if you come to the hospital with a urinary tract infection, skin infection, or sore threat.

Over time, some strains of bacteria have become resistant to certain common antibiotics. You may have heard of some of these common healthcare associated infections: MRSA, C-Diff (Clostridium Difficile) and VRE (Vancomycin Resistant Enterococcus) are some of the most common.

So back to Mr. Z…
How did he end up with MRSA overnight? Here is a breakdown:
  1. When Mr. Z came into the hospital he had a diagnosis of cellulitis, or an infection of the skin. Cultures were obtained in the emergency room and sent to the laboratory for processing.
  2. From there, the laboratory grew these cultures in a petri dish in the incubator for a day. They then were able to look under the microscope and identify that the bacteria infecting his skin was staphylococcus aureus.
  3. From there, with this information, they spent the following two days testing the bacteria’s response to the most commonly use antibiotic (methicillin) as well as other antibiotics. This is known as testing for sensitivities (hence the test name you may have heard used: culture and sensitivity).
  4. Once the initial sensitivity testing was complete, it was easy for the lab to identify Mr. Z’s infection as MRSA.
  5. The lab then notified the nurse caring for Mr. Z at the time of the completion of testing, and the nurse ensured that all contact precautions were put in place at that moment.
So, what happens from here?
First of all, don’t fret. The average nurse is unlikely to contract an antibiotic resistant infection from a patient if standard precautions were appropriately used. Since Mr. Z has MRSA, he will need to be treated with another antibiotic that the bacteria showed sensitivity to. He may also need a longer course than normal, depending on his response to therapy. This will be decided upon by the attending physician or infectious disease specialist. Your job, as the patient’s nurse, is to make sure the patient receives all prescribed treatment and monitor for further complications from here onward.

You also will now play an essential role for this patient with an antibiotic resistant infection. As the main healthcare professional in contact with this patient as they are receiving treatment, it is imperative to follow strict contact precautions (disposable gown and gloves are the standard requirement for MRSA infected patients at this time) not only to prevent yourself from contracting the infection, but even more importantly to protect other patients you come into contact with from becoming infected. When proper precautions are taken, you can stop the spread of these potentially deadly bacteria.

This post comes from Marina Matsiukhova at nurse.plus. We specialize in creating NCLEX-RN practice tests, our other resource is cna.plus, which helps CNAs prepare for their certification.





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